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Gastrointestinal system

Gastrointestinal system




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USMLE® Step 1 questions

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High Yield Notes

27 pages



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USMLE® Step 1 style questions USMLE

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A 61-year-old man is brought to the emergency department by his partner after a 2-day history of abdominal pain, fever, and altered mental status. He is oriented only to self and is unable to name the city in which he lives or the current year. The patient has a history of chronic alcohol use and was found to have cirrhosis several years ago. His other medical conditions include hypertension, hypercholesterolemia, and type II diabetes mellitus. His temperature is 39.0°C (102.2°F), pulse is 109/min, and blood pressure is 130/84 mmHg. Physical examination reveals jaundice and palmar erythema. The abdomen is tense, distended, and tender to palpation. Shifting dullness to percussion is present. Which of the following is the most likely cause of this patient’s clinical presentation?

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Alcoholic cirrhosis p. 69, 400

cholelithiasis and p. 405

Alcoholism p. 595

cirrhosis and p. 398


cirrhosis p. 398


cirrhosis p. 398

Anorectal varices

cirrhosis as cause p. 398


cirrhosis p. 398

Asterixis p. 80, 537

cirrhosis p. 398

Cirrhosis p. 398

α1-antitrypsin deficiency p. 401

alcoholic p. 69, 400

bacterial peritonitis (spontaneous) p. 399

cholelithiasis and p. 405

cystic fibrosis p. 58

encephalopathy with p. 400

esophageal varices and p. 386

fructose intolerance p. 78

granulomatous disease p. NaN

gynecomastia p. 673

hemochromatosis p. 404

hepatocellular carcinomas p. 401

hyperbilirubinemia in p. 402

loop diuretics for p. 632

non-alcoholic fatty liver disease p. 400

pleural effusion p. 705

portal hypertension p. 398

serum markers for p. 399

Wilson disease p. 404

Edema (generalized)

cirrhosis p. 398

Gynecomastia p. 673

cirrhosis p. 398

Hepatic cirrhosis p. 705

Hepatic encephalopathy p. 400

cirrhosis p. 398


cirrhosis p. 398

Hepatocellular carcinomas p. 401

cirrhosis and p. 398

“Hobnail” liver in alcoholic cirrhosis p. 400


cirrhosis and p. 398


alcoholic cirrhosis as cause p. 400

Hyponatremia p. 615

cirrhosis and p. 398

Jaundice p. 402

alcoholic cirrhosis and p. 401

cirrhosis p. 398

Liver disease

cirrhosis p. 69, 78

Peripheral edema

cirrhosis and p. 398


with cirrhosis p. 398

Portal hypertension p. 398

cirrhosis and p. 398


cirrhosis p. 398

Spider angiomas

cirrhosis p. 398


cirrhosis p. 398

Testicular atrophy

cirrhosis p. 398

Thrombocytopenia p. 415

cirrhosis p. 398


Content Reviewers

When cells are injured or damaged and die off, usually that dead tissue that was previously full of living cells becomes fibrotic, meaning it becomes thickened with heaps and heaps of protein and forms scar tissue.

So when your liver is constantly forced to process alcohol like in alcoholic liver disease, or subject to a viral attack for a long time like in HBV, or anything else that causes a long-term or chronic state of liver cell or hepatocyte destruction and inflammation, your liver can become seriously scarred and damaged to the point where it’s no longer reversible, at which point it becomes fibrotic and in the liver we call this process cirrhosis.

Because it’s usually irreversible, cirrhosis is often referred to as “end-stage” or “late-stage” liver damage.

When liver cells are injured, they start to come together and form what are called regenerative nodules. You can think of these as colonies of living liver cells. These are one of the classic signs of cirrhosis and are why a cirrhotic liver is more bumpy as opposed to a smooth, healthy liver.

Also with cirrhotic liver tissue, you’ll see that in between these clumps of cells or nodules, is fibrotic tissue and collagen.

Here’s a classic histology image of cirrhotic tissue, this clump of cells in the middle is the regenerative nodule, and these blue stains surrounding it are the bands of protein from the process of fibrosis.

If we zoom out a bit and look at it with the naked eye, we’ll again see these nodules, which have fibrotic protein bands in between.

How do these bands of fibrotic tissue form though? Well fibrosis is a process mediated by special cells called stellate cells, that sit between the sinusoid and hepatocyte, known as the perisinusoidal space.

Here’s a pretty basic layout of the basic functional unit of the liver, you’ve got the portal vein and hepatic artery that combine into a sinusoid, which then goes into the central vein, and these are all lined with hepatocytes.


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